Laserfiche WebLink
PERMITTEE NAMEJADDRESS NncludeFacilim %'ame'leNaiu„, o PtIftovnu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />Form Approved. <br />OMB No. 2040.0004 <br />F - FINAL FSL AN <br />f2Fi- 1 LGAUt7U t TO RED WA;;H , <br />NOTE: Read Instructions before comoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br /> PERMIT ti <br /> REQUIREMENT <br />f SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />i I _ REQUIREMENT I ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : : fi ti # r .. <br />< REQUIREMENT r-, > <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT ?• ,. a :; qty ,.f.! <br />r. - - r>r+".;= REQUIREMENT I <br /> SAMPLE <br />;'• MEASUREMENT <br /> <br />PERMIT 1 -AT <br /> REQUIREMENT = <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I .ertify under pcnelty of law that this do wnent and all attachments were <br />d <br />d <br />d <br />di <br />t <br />d <br />th <br />t <br />d <br />i TELEPHONE DATE <br />?? ?! <br />. ' ance wi <br />a sys <br />es <br />epare <br />un <br />er m% <br />rection or super <br />ston to accor <br />em <br />gne <br />: • ussure that qualified personnel properly gather anti evaluate the mfomtatum -- <br />k <br />_ ?1??// ?• I' : - - ;uhmitted Based on m% tnqurn of the person or persons wha manage the wstcm <br /> . <br />or those persons dircdly rrslvinsihlr far gathcnnp the m(ormntiun, the info'mati'n <br /> submitted u, to the best of my knowledge and belief, true, accurate, and rontplP1i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that there arc significant penalties for submnting false mtomiation <br /> ' OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED vxludnig the po,thihty of fine and imprisonment for knowing %wlations CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence all attachments here) <br />ca=r <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. .dtll$ 1S a 4,part lulm.